The Truth Behind the Most Common Medicare Myths
Separating Medicare fact from fiction
Reviewed by: Michael Howard, Licensed Insurance Agent. Written by: Aaron Garcia.
Many misleading Medicare myths can impact you, including how much you pay and how you enroll.
False Medicare myths include: You are automatically enrolled in Medicare when you turn 65, and Medicare coverage is free.
Pre-existing conditions CAN still impact your Medicare policy if you plan to use Medigap.
Do you want to know the truth about Medicare? It can be a tricky process. And because of that, several Medicare myths can cause you to make some serious mistakes with your coverage. Here’s a list of the common myths we hear and what you need to know to help with this process.
- Medicare Advantage: Your rate and plan were determined mostly by the area you live in and the providers you can visit. Moving, unless it’s nearby, can cause your MA plan to change completely, both in the doctors you see and the rates you pay.
- Part D: Medicare’s drug plans classify prescription drugs into different lists and tiers, called formularies. A carrier’s formulary in one state may vary from its formulary in another. You may pay more, or less, for your prescriptions if you move to another state.
Reality: This widely believed myth is false. The confusion stems from the fact that some people may be automatically enrolled in Medicare Part A when they turn 65, but this typically only happens if they’re already drawing social security benefits.
Is Medicare Part B required by law? Part B gives you the option to enroll, but delaying enrollment unless you have creditable coverage can lead to serious financial consequences.
Reality: False, false, and false. Don’t get us wrong; Medicare Parts A and B offer excellent coverage and will take care of many of your hospital and medical bills. It rarely provides everything a patient needs, however. Instead, you’ll want to factor in additional costs for the following services:
- Prescription drugs
- Long-term care
Reality: This is false, beginning on January 1, 2021. Before then, patients with ESRD couldn’t sign up for Medicare Advantage. The change is one of several for 2021, and means that ESRD patients can take advantage of the out-of-pocket maximums that many MA plans offer while still paying the same prices for the critical services they need. 
Reality: Sorry to burst your bubble, but this is false. What Medicare is free? Well, there’s a good chance you’ll receive at least a portion of your coverage at no charge; if you worked at least 10 years, you’re probably eligible for no-cost Medicare Part A coverage.
Part B and Part D both have a monthly premium. Most Medicare Advantage plans bundle Part A, Part B, Part D., and provide options that Original Medicare doesn’t.
Reality: False; Part A and Part B are different policies. Part A covers hospital bills and is usually available at no cost if you worked 10 or more years. If you worked less than 10 years, you may have a Part A monthly premium. Part B, also known as medical coverage, is income-based and comes with its own monthly payment — no matter how long you worked.
Reality: This may be true, but mainly if you retire after you’ve turned 65 — the age you become eligible for Medicare. And unless you had other creditable coverage until then, delaying your enrollment can bring some stiff penalties.
Reality: False. Obamacare, or The Affordable Care Act (ACA), made it illegal for insurance companies to deny coverage because of a pre-existing condition. This includes Medicare. As long as you’re 65 or older, and a legal U.S. citizen, you can’t be denied Medicare coverage because you’re in poor health.
Reality: This is mostly true, unless you missed your enrollment period for Medicare Supplement Insurance (Medigap). You have a six-month window to enroll in a Medigap plan when you turn 65. If you enroll during this time, an insurance company can’t deny you coverage or institute a waiting period due to a pre-existing condition.
However, missing this enrollment period could mean you’ll be subject to medical underwriting by the insurance company when you do enroll. In this case, the company can deny your coverage because of a pre-existing condition.
Reality: False. Many Medicare enrollees think a good Medigap plan will provide the same benefits as Medicare Advantage, but Medigap plans are designed to work alongside Medicare Parts A and B. Medigap plans typically cover costs over and above what Parts A and B cover — they don’t replace them.
Medicare Advantage, on the other hand, is a popular choice because it often combines your Parts A and B and usually includes a prescription drug plan, while Medigap plans do not.
Reality: False. Medicare and Medicaid are two separate programs. Medicare is government-sponsored health insurance that’s available to all Americans aged 65 and older. Medicaid is a state and federal program that assists low-income individuals and families. The two do work together when a patient has been deemed dual-eligible.